Ergogenic supplement use was significantly associated with several health risk behaviors. Individuals who used ergogenic supplements were more likely to drink alcohol, more likely to drink heavily, more likely to ride in a vehicle with someone who had been drinking, more likely to drive after drinking, and more likely to have been in a physical fight compared with those who had not used supplements Table 1.
Men were more likely to use ergogenic nutritional supplements than women (P <.001). No difference in the pattern of supplement use was noted relative to age or body mass index. An equal number of respondents (70%) felt that creatine, androstenedione, and anabolic steroids were all effective at building muscle strength. Men, respondents younger than 20 years, and individuals who reported using ergogenic supplements were all more likely to believe in the effectiveness of creatine, androstenedione, and steroids compared with others (P <.05).
Discussion
Our study has 3 important findings: (1) a significant number of young people have used ergogenic supplements; (2) a similar majority of respondents believe creatine, androstenedione, and anabolic steroids are effective with respect to gains in muscle strength and mass; and (3) use of nutritional ergogenic supplements is associated with certain high-risk health behaviors.
Although it has been reported that 38% of high school athletes use vitamin supplements,10 the prevalence rates of creatine or androstenedione use in adolescents are not known. Our study suggests that a significant number of young persons use ergogenic supplements, creatine in particular. The self-reported prevalence rate of 41% of individuals who have used ergogenic supplements represents a baseline that needs to be verified by further studies.
A majority of respondents (70%) believed that creatine and androstenedione are effective in increasing muscle strength. There is limited evidence to support this in the medical literature. This is important given the credibility gap the medical community created when discussing anabolic steroids with athletes and adolescents in the past. Physicians routinely counseled that steroids were ineffective in building muscle strength and mass. Athletes’ experiences in the gym and on the playing field proved otherwise,11 however, and a pervading sense of mistrust developed among athletes toward the medical community.12 Our study shows that many young individuals believe that ergogenic supplements are effective. Some of this belief may stem from word of mouth,13 some from savvy marketing, and some from perceived experience. Whatever the case, physicians must be careful to provide accurate clinical information, while not alienating patients, when discussing ergogenic supplements. Our results also suggest that individuals who have used ergogenics are more likely to believe in their effectiveness. This agrees with the model suggesting that users of “natural” products are more likely to believe in their safety and efficacy than nonusers.14
Finally, and perhaps most important, our study indicates that supplement use is associated with certain health risk behaviors. Specifically, ergogenic supplement users are more likely to drink alcohol heavily, ride as a passenger with a driver who has been drinking, drive after drinking, and get involved in a physical fight. A similar pattern of behavior has been described among adolescents who use anabolic steroids.15 Although the prevalence of anabolic steroid use in the general adolescent population has been estimated at 3% to 10%,16,17 our study shows a much higher rate of ergogenic supplement use. This establishes an important link in behavioral data between nutritional supplement users and anabolic steroid users. While steroids are illegal, ergogenic supplements are readily available. If, as our results suggest, ergogenic use is associated with a risk-behavior syndrome similar to that seen with steroid use, this is a valuable marker for physicians to use to provide targeted preventive counseling.
Limitations
Our study, however, has several important limitations. The respondents were all military recruits. Caution must therefore be used before generalizing the results to an unselected population. The prevalence of risk behaviors reported by the respondents relative to data from the 1999 YRBS18 also show several important differences Table 1. Our respondents appear more likely to drink, less likely to ride with someone who had been drinking, more likely to smoke, more likely to wear a seatbelt, less likely to fight, and less likely to report symptoms of depression compared with general data from the YRBS. The prevalence of other risk behaviors appears to be similar. It is uncertain whether these behavioral differences are particular to a military population. Another limitation of our study is the use of self-reported data, which potentially introduces a significant recall bias.
Conclusions
Our study suggests that in a young healthy military population there is widespread belief that creatine and androstenedione are effective ergogenic agents. The prevalence of supplement use in this population is significant, and such use is associated with certain health risk behaviors. This pattern of behaviors appears similar to a risk-behavior syndrome previously noted with anabolic steroid use. Clinicians should routinely ask adolescents and athletes about their use of dietary supplements. They should ask which supplements their patients are using, why they are using supplements, and what doses they are taking. Clinicians should be alert so they can provide targeted preventive counseling for individuals who are identified as users of ergogenic supplements.